Abstract
Isolated dissection of the superior mesenteric artery (SMA) usually occurs idiopathically, and trauma-related onset is extremely rare. A 71-year-old woman presented with isolated SMA dissection caused by blunt trauma sustained in a traffic accident. On admission, she had a Glasgow coma scale score of 10. Computed tomography (CT) of the head revealed a brain contusion and subdural hematoma. Contrast-enhanced CT of the abdomen indicated an isolated SMA dissection. The patient underwent urgent craniotomy. Considering that she sustained a severe brain injury and did not exhibit bowel ischemia on CT findings, we provided conservative therapy without anticoagulants. However, abdominal distention was observed, after 3 days, and a repeat CT revealed total occlusion of the true lumen of the dissected SMA and intramural gas bubbles in the dilated small intestine. We performed a laparotomy and found that a large part of the small intestine was necrotic, which we then resected. In the treatment of SMA dissection, it is important not to miss the signs of bowel ischemia. If a patient cannot report symptoms because of a conciousness disturbance such as in this case, frequent evaluation using CT is needed, and early, sometimes prophylactic intravascular intervention can be useful.
